Relationships and mental illness

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Mental illness impacts significantly on relationships. Here we examine the dynamic between mental disorder and relationships by reviewing attachment theory, and using bipolar disorder and schizophrenia as examples to explore the issues. Lecture given to Relate Leicester, August 2013.

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Relationships and mental illness

  1. 1. Mental illness and relationships Dr. Nick Stafford, Consultant Psychiatrist NHS & Private Practice clinical-partners.co.uk Seminar & discussion with RELATE Leicester July 2013
  2. 2. Disclosures Pharmaceuticals Astra Zeneca Ltd Otsuka Ltd Bristol Myers Squibb Ltd Glaxo Smith Kline Ltd Pfizer Ltd Eli Lilly Ltd Lundbeck Ltd Servier Laboratories Ltd GW Pharma Ltd Private Practice Clinical Partners Ltd Nuffield Health BMI Healthcare Clinics in: London, Leicester, Sutton Coldfield Previously Vice Chair Bipolar UK
  3. 3. Contents of talk • Fundamentals – Self, Attachment, Development, Social cognition • Personality & disorder • Bipolar disorder as a model • Families • Services and health care professionals • Film examples
  4. 4. Summary – systemic model Individuals Illness Response to stress Treatment Education / Knowledge
  5. 5. The brain is our lens of the world
  6. 6. Perception determines relation
  7. 7. Mental illness / Relationship System Mental illness Relationship Protective factors Individual style Attachment style Communication Expressed emotion Nature Degree Treatments Impairments Personality
  8. 8. What makes the self? Self Others World Bio Psycho Past
  9. 9. Relationships Spouse Children Friends Colleagues Neighborhood BRIEF ENDURING
  10. 10. Social sciences Psychology Social Work Sociology Anthropology Doctor
  11. 11. Insight
  12. 12. Regulations Law Custom Agreement Groups Society
  13. 13. Attachment Me ATTACHMENT Mummy The World Self Development AdultLife
  14. 14. Attachment style (childhood) Attachment styles Secure Insecure Anxious avoidant Ambivalent Disorganised
  15. 15. Theory of mind
  16. 16. Development Acquaintance Build Up Continuation Deterioration Termination BEGINNING ENDING
  17. 17. Adult attachment Secure Anxious- preoccupied Dismissive- avoidant Fearful- avoidant Some forms of psychological maladjustment and clinical disorders are attributable in part to the effects of insecure working models and attachment styles.
  18. 18. Security based strategy of affect regulation Secure Anxious- preoccupied Dismissive- avoidant Fearful- avoidant Self-esteem thoughts about the self Sociabilitythoughtsaboutothers Positive Negative Positive Negative
  19. 19. Security based strategy
  20. 20. Attachment avoidance strategy
  21. 21. Hyper-activation strategy
  22. 22. BIPOLAR DISORDER An example mental disorder
  23. 23. Relationships in bipolar • Key relationships – Divorce is twice as common – Loss of employment is twice as common • Deficits in social cognition underpin these disabilities • Treatments for these principal deficits – Psychoeducation – Functional remediation – DBT • Things that don’t work – CBT – Counselling
  24. 24. Bipolar disorder comorbidities • Anxiety disorders • Eating disorders • Alcohol and substance misuse disorders • Impulse control disorders • Behavioural addictions • Personality disorders (esp. Cluster B) • Medical problems – CVS, CVA, Cancer, etc. • Psychosocial problems
  25. 25. COGNITION
  26. 26. Social cognition - Bandura
  27. 27. Social mirroring neurons
  28. 28. The Root – Cognitive deficits
  29. 29. PERSONALITY
  30. 30. Personality (the study of) • Changes • Development • Disorder • Genetics • Pathology • Psychology • Style • Systematics • Tests • Type • Traits • Measuring
  31. 31. Personality types & disorder Personality type • Hippocrates four temperaments – Yellow bile, Black bile – Phlegm, Blood • Eysenck – Extraversion / Neuroticism • Myers-Briggs – Extraversion / Introversion – Sensing / Intuition – Thinking / Feeling – Judging / Perception Personality disorder (Type A,B,C) • Paranoid • Schizoid • Schizotypal • Antisocial • Borderline • Histrionic • Narcissistic • Avoidant • Dependent • Obsessive-Compulsive
  32. 32. Paul Abbott
  33. 33. COMMUNICATION
  34. 34. Communication styles Passive Aggressive Passive- aggressive Assertive
  35. 35. Communication • How is this impacted on by the illness? • Bipolar – Mood state affects style of communication • Depression predominates – Passive • Mania disinhibited – Aggressive & Passive aggressive – Thinking style can be different (social cognition) – Relating styles affected by cognitive deficits (facial emotional recognition …)
  36. 36. MOOD AND EMOTION
  37. 37. Emotions • What are they? • Why have they evolved? • How can they be helpful? • How can they be unhelpful?
  38. 38. Moods – Depression
  39. 39. Why do people with bipolar have relationship problems? • The impact of mania and depression • Subsyndromal symptoms – Irritability – Depression • Comorbid axis I disorders • Personality traits and disorders • Sleep disorders • Treatments
  40. 40. Moods – Mania
  41. 41. Irritability • Negatively affects ability to moderate emotions during social interaction • Easily argumentative • Evokes negative emotions in others • Difficult for sufferer to distinguish their own irritableness • Unpleasant to be around • This is a predominant mood state in mania, depression and sub-syndromal states
  42. 42. OTHER PROBLEMS
  43. 43. Social anxiety disorder • More than 80% of bipolars suffer with this • Disabling anxiety in the context of mixing with others • Avoidance of social contact leads to increased social anxiety
  44. 44. Alcohol and substance misuse • 60% of bipolars suffer alcohol dependence at some point in their lives – Worsens illness prognosis – Increases other comorbidities – Reduces interpersonal functioning – Reduces occupational functioning – Cost – Domestic violence
  45. 45. Impulse control disorders • Varied and can be pervasive • Impulsive behaviour causes the person to lack judgment • Consequential damage to self, others and relationships
  46. 46. Behavioural addictions • Sex – Could be a problem even if kept within a faithful relationship • Gambling – Amounts of money wasted can be staggering • Spending – Typically when high but also when low
  47. 47. Medication impact on a relationship? • Overall improvements due to the treatment and improvement of the illness • Side effects – Impact on communication (sedation) – Libido, impotence, delayed ejaculation
  48. 48. FAMILY FACTORS
  49. 49. Families - High expressed emotion FAMILY PATIENT HOSTILITY EMOTIONAL OVER- INVOLVEMENT CRITICAL COMMENTS STRESS ILLNESS
  50. 50. Families - Low expressed emotion FAMILY PATIENT MORE EDUCATED FAMILY DON’T HAVE TO PUT UP WITH THE ILLNESS FEEL PATIENT DOES NOT HAVE CONTROL OVER ILLNESS MORE RESERVED WITH CRITICISM STRESS ILLNESS
  51. 51. TREATMENTS, SERVICES, RESOURCE S
  52. 52. DBT • Dialectical behavioural therapy • Training yourself to become more aware of your emotions and how they impact on you • Form of psychotherapy • Marsha M. Linehan • Original use EUPD • Mindfulness • Distress tolerance • Emotion regulation • Interpersonal effectiveness
  53. 53. Services for Relationships • Generic psychiatric services • GP counselling • Rethink (carers) • Relate (couples) • All services to some degree assist • Community institutions
  54. 54. Impact of health professionals • All health care professionals should play a key role in a patient’s relationships – Assessment and identification – Education – Treatment – Therapy • ‘Negative’ impact of HCPs on relationships – Changes lead to relationship revaluations – Discovery of abuse
  55. 55. Summary – systemic model Individuals Illness Response to stress Treatment Education / Knowledge
  56. 56. Overcoming
  57. 57. Resources
  58. 58. Resources
  59. 59. THANK YOU

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